Skinterview with Mohs Surgeon and Dermatologist, Dr. Bishr Al Dabagh

Dr. Bishr Al Dabagh is a board-certified dermatologist and fellowship-trained dermatologic surgeon. He focuses on the diagnosis and treatment of skin cancers, Mohs micrographic surgery, reconstruction, and cosmetic procedures. We asked Dr. Bishr Al Dabagh to answer your top skin cancer, sun protection, and skin care questions in the following skinterview. We hope you skinjoy!

Skinterview with Dr. Bishr Al Dabagh:

Dermveda: You focus on Mohs Micrographic surgery, could you tell our followers a bit about Mohs and what sparked your interest in it?

Dr. Al Dabagh: Mohs surgery is a highly specialized technique that removes skin cancer while preserving as much normal tissue as possible. It also has the highest cure rate for the removal of certain types of skin cancer, mainly basal cell and squamous cell carcinoma. It is namely used for skin cancers in the head and neck area, where the preservation of normal tissue is needed. It is also used for recurrent or aggressive skin cancers. It is a safe procedure performed in an outpatient setting under local anesthesia. The Mohs surgeon removes the skin cancer then the tissue is processed in the lab to make slides. The Mohs surgeon then reads the slides and makes a map of the tumor. If the skin cancer is not fully removed, then more tissue is removed and the process is repeated. Once the cancer has been fully removed, then the Mohs surgeon performs reconstruction to repair any defect left after the Mohs surgery. I chose to this focal area because I really enjoy the process of performing Mohs surgery and the surgical experience in an outpatient setting. 

Dermveda: How can people with skin cancer know if Mohs is right for them?

Dr. Al Dabagh: Mohs surgery is performed on basal and squamous cell carcinoma located in critical areas, such as the face, neck, genitals, hands, and feet. Large, recurrent, or aggressive tumors are also removed by the Mohs technique. Your dermatologist will refer you to a Mohs surgeon when appropriate. Sometimes skin cancer can be treated by other modalities, including traditional surgical removal, scraping and burning, freezing, radiation, or topical treatment. The right treatment will depend on the type, location, and size of cancer. Mohs surgery, while having a high cure rate, may not be the most appropriate treatment for your cancer. See your dermatologist to discuss the most appropriate treatment. 

Dermveda: What are your best preventative tips for avoiding skin cancer and sun damage?

Dr. Al Dabagh: Ultraviolet radiation from the sun is the major culprit when it comes to skin cancer. Sustained DNA damage causes skin cells to become cancerous. Therefore, avoiding too much sun exposure is key. Most of our sun damage occurs when we are young. However, sun protective clothing, sun avoidance at peak times of the day, using sunscreen, and avoiding tanning beds can all help prevent skin cancer as we grow older. Skin cancer may occur in people of all skin types and ethnicities, so it is important for everyone to be sun conscious. Protecting newborns and young children is also very important - they will thank you when they are adults!

Dermveda: What do you wish more people knew about their skin?

Dr. Al Dabagh: I wish people respected the sun more. The sun causes photoaging, wrinkles, thinning skin, and, most importantly, skin cancer. I wish people recognized the amount of sun they get every day just doing normal daily activities, such as walking to their car, driving, sitting by a window, mowing the lawn, etc. Even on cloudy days we are exposed to UV light and can get a sunburn! Many of my patients wish they were smarter about sun exposure during their earlier years. Unfortunately, for many of them, most of the damage has already been done. I hope that the young people out there realize this before it is too late. 

Dermveda: What can your patients do to help you help them?

Dr. Al Dabagh: Skin exams are important, especially for people who have had a lot of sun exposure. Get to know your skin and make sure you point out any new, growing, or concerning lesions to your dermatologist when you have a skin exam. The ABCDEs of melanoma are important to look for. These include: Asymmetry, Border irregularity, Color change, Diameter greater than a pencil eraser, and Evolution-changing mole. If you have a history of sun exposure or skin cancer, then regular skin checks are a must. Make sure to go to your appointments so that your skin cancers are caught early.

Dermveda: How can our followers find a dermatologist practitioner that’s the right fit for them?

Dr. Al Dabagh: I would suggest finding a board-certified dermatologist near you. The American Academy of Dermatology website will help you locate a dermatologist in your area. Make sure that your dermatologist is available to see you for any concerning lesions that may arise and that they do thoroughly skin checks especially if you have a personal or family history of skin cancer. If you have a skin cancer that requires Mohs surgery, make sure that you see a fellowship-trained Mohs Surgeon (American College of Mohs Surgery). These Mohs surgeons have gone through extensive training to give you the best surgical care possible. Make sure you ask questions and feel fully informed about your diagnosis and treatment options.